The routine induction of labor among women with preexisting type 1 and type 2 diabetes before pregnancy is a common practice and rightful under individual circumstances. But according to recent findings published in BMJ Open Diabetes Research and Care, it is also associated with certain neonatal complications related to deliveries before 38 weeks.
“Based on this population-based, retrospective data, delivery of women with preexisting diabetes before 39 weeks’ gestation is associated with a higher rate of neonatal complications and does not reduce the cesarean section rate,” said lead researcher of the study, Howard Berger, MD, head of maternal fetal medicine at St. Michael’s Hospital, Toronto. “Clinicians are often faced with the dilemma of when to deliver pregnant women with preexisting type 1 and type 2 diabetes. On one hand, it is known that pregnancies in women with preexisting diabetes are at increased risk for certain complications, including stillbirth and the development of preeclampsia. This has led to many clinicians electively choosing to deliver these women before 39 weeks’ gestation, but the price that is paid is an increase in early-term deliveries, which carry with them an increase in certain neonatal complications.”
According to Mayo Clinic, labor induction carries various risks, including:
- Failed Induction:About 25 percent of women, will often start with an unripened cervix and may need an emergency C-section when labor stalls.
- Low Heart Rate: The medications used to induce labor — oxytocin or a prostaglandin — might cause abnormal or excessive contractions, which can diminish a baby’s oxygen supply and lower a baby’s heart rate.
- Infection: Some methods of labor induction, such as rupturing a mother’s membranes, might increase the risk of infection for both mother and baby.
- Uterine Rupture:This is a rare but serious complication in which the mother’s uterus tears open along the scar line from a prior C-section or major uterine surgery. An emergency C-section is needed to prevent life-threatening complications and the possible removal of the uterus.
- Post-Partum Hemorrhage and Bleeding After Delivery:Labor induction increases the risk that a mother’s uterine muscles won’t properly contract after they give birth (uterine atony), which can lead to serious bleeding after delivery.
Also, newborn intensive care unit admission rates are higher when induction is present than mothers who experience spontaneous labor.
A Review of the Cohort Study
The researchers analyzed data from women with diabetes before pregnancy who had a singleton birth at 38 weeks’ gestation or later. The researchers wrote:
- Women with placenta previa, previous cesarean section, and women diagnosed with gestational hypertension or preeclampsia before 38 weeks were excluded.
- The cohort was divided into two exposure groups to mimic the real-life dilemma faced by a health care provider: whether to induce at 38 weeks’ gestation or expectantly manage until at least 390/7
- Women who underwent induction of labor between 380/7and 386/7 weeks were compared with those expectantly managed and who remained undelivered by 390/7
- Within the cohort, cesarean delivery occurred among 269 women in the induced labor group and among 333 women in the expectantly managed group.
- Rates of instrumental delivery were 11.2% and 10.2% for the induced labor group and the expectantly managed group, respectively.
Although this was a random sampling of women, the ultimate conclusion was that routine induction of labor among women with diabetes before pregnancy is not associated with an increase in the rate of cesarean delivery, but is associated with certain neonatal complications.
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